The
Low-Down On The Diagnosis And Therapy Of
Coronary Heart Disease In Women

It is not easy to diagnose CHD in
women who develop chest pain more often than men. The chances for these chest
pains to progress to heart attack are rare. In one study, half of the women
undergoing coronary angiography did not have significant heart artery blockage.
But, women with classical angina symptoms had a 71 percent probability of having
diseased coronary arteries. Nearly 90 percent of women suffering from heart
attack had chest pains as the initial clinical presentation. This is similar to
what men have experienced. Nevertheless, females are more likely to exhibit
symptoms such as breathlessness, fatigue, nausea, or upper abdominal pain.

Diagnosis of CHD among women has
often been a challenging task for doctors. Resting electrocardiogram (ECG)
frequently shows non-specific abnormalities in women, regardless of whether
there is underlying CHD. The conventional treadmill stress test also does not
help much as a diagnosing tool for women. Non-invasive tests such as myocardial
perfusion stress imaging and stress echocardiography may improve the sensitivity
and specificity over the treadmill stress tests in the female population.

Several reports have documented
that women with CHD have a worse outcome than their male counterparts. Compared
to males, females have higher chance of complications after heart attack. This
could be explained by:

Older age of female
CHD patients, usually 10 years older than male CHD patients.

Increased likelihood
of co-morbid conditions such as high blood pressure, diabetes, and
heart failure.

Differences in the
size of the coronary arteries between men and women.

A greater likelihood
of urgent surgical or interventional procedures in women.

Less aggressive
approach generally adopted by doctors.

Lower likelihood of
referral for cardiac rehabilitation after a cardiac event

Pharmacological therapy using ACE
inhibitors, aspirin, beta-blockers, nitrates and cholesterol-lowering drugs has
been effective in both men and women.

A 1987 study showed that men were
6.3 times more likely than women to be referred to coronary angiography when
their non-invasive tests were abnormal. Heart procedures such as PTCA (Percutaneous
Transluminal Coronary Angiography) and bypass surgery were 15 to 27 percent more
commonly carried out in men than in women with the diagnosis of CHD.

Complications during PTCA were
higher for female patients. A slightly worse operative mortality was also
associated with surgical treatment for women. After the heart bypass surgery,
women have a lower likelihood of being free of angina than men do. Female CHD
patients also experience greater disability and less return to work than the
male patients. The rate of long-term survival and re-operation, however, are
similar.